Coverage and effect of intensive adherence counseling on viral load suppression in a public HIV Care Center, Kampala, Uganda: A mixed methods retrospective study January 2015 to October 2018
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Background: Intensive adherence counseling (IAC) is fundamental to enhance adherence and increase durability of ART regimens among ART treated unsuppressed people living with HIV (PLWH). This study evaluated coverage, effect and experience of providing IAC in an urban HIV care center, Kampala, Uganda. Methods: This was a sequential explanatory mixed-method study that compared viral load suppression during IAC implementation (intervention) to the period before IAC at Kisenyi Health center IV. Data were from patient files and viral load register. The effect of IAC on viral suppression and associated factors were analyzed using modified Poisson regression with robust standard errors. Qualitatively, the experiences of providing IAC among health workers were obtained using in-depth interviews and analyzed using an inductive approach in Atlas.ti.8 Results: A total of 500 records were sampled: 249 (49.8%) in the intervention period and 251 (51.2%) in the pre-intervention period. The mean age was lower during the intervention period 33.1 (±12.0) than 36.5 (± 13.4) in the pre- intervention period, p=0. 002. The median duration on ART was 924 days (IQR=375-1552). More clients were currently on Protease based regimen in the pre-intervention period 179 (71.3%) than 135 (54.2%) in the intervention period, p=<0.001. In the intervention period, all eligible clients received IAC [249/249 (100.0%)]. Overall, 325 (65.0%) received IAC and of these, 143 (44.1%) achieved viral load suppression compared to 46 (26.3%) who received regular counseling. Receiving IAC was significantly increased suppression by 22% (aRR = 1.22, 95% CI: 1.01-1.47). Clients on protease inhibitor (PI) based ART regimen were 89% less likely to suppress (aRR= 0.11, 95%CI: 0.08-0.15). Qualitatively, health workers exhibited a clear understanding of IAC procedures and applauded its role in improving adherence at KHCIV; however, non-disclosure, social economic constraints, suppression during IAC. Conclusions: Receiving IAC increased viral suppression; however, its effect was suboptimal despite optimal coverage due to patient and health care system related factors. Provision of adequate IAC necessities and use of patient centered approach should be emphasized to obtain the maximum benefit of the intervention.